Online tobacco cessation training & competency assessment for CAM practitioners Abstract Despite decades of public health efforts tobacco use remains the leading preventable cause of death in the US. As a significant and increasing proportion of the US population utilizes complementary and alternative medicine (CAM), CAM practitioners are a critical part of the US health system. Yet these practitioners have been largely left out of the nation's public health agenda promoting healthy lifestyle behaviors. To address this gap in public health policy, University of Arizona researchers have developed an in-person tobacco cessation BI training and office system intervention specially tailored for the unique needs of acupuncturists, chiropractors, and massage therapists (CAM practitioners) as part of the current NCI-funded CAM Reach Project (CAMR). The long-term goal of CAMR is to help all chiropractors, acupuncturists, and massage therapists to integrate recommendations from the PHS tobacco dependence treatment guideline into their routine practice. This ambitious goal will be more feasible with development of cessation training programs, tailored for CAM practitioners, which are accessible, acceptable, and scalable. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of web-based training for health professionals, web-based evaluation of clinical skills competency is still under developed. To realize CAM practitioners' potential to promote tobacco cessation and use of guideline-based treatment, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors, e.g. social influence and insurance reimbursement. Insurance reimbursement for tobacco cessation BI services is now widely available for conventional medical practitioners, but this is not the case for CAM practitioners affiliated with insurers. Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. Thus, in preparation for a larger dissemination trial to examine the effect of trainng and reimbursement on CAM practitioner cessation practices, the Specific Aims of this developmental proposal are to: 1) Adapt an existing in-person tobacco cessation brief intervention training program that is specifically tailored for chiropractors, acupuncturists, and massage therapists for delivery via Internet, 2) Develop a novel, web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient, 3) Pilot test the web-based CAMR training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and 4) Conduct mixed methods formative research on factors influencing practitioner tobacco cessation behaviors, focusing on, practice environment, peer social influence, and insurance reimbursement.